There are now millions of cases worldwide of COVID-19 infection. As cases continue to soar, researchers around the globe are working urgently to identify risk factors and possible treatments.

People with blood disorders and underlying immune deficiencies are at heightened risk of severe COVID-19 infection. In addition, many chemotherapies, immunotherapies, and stem cell transplants used to treat these diseases further suppress the immune system, and it has been established that COVID-19 infection can trigger clots and other hematologic complications in some individuals. The global hematology community continues to leverage specialized labs, knowledge, and treatments to help predict high-risk groups and improve treatment options for patients suffering from COVID-19.

Studies presented during the 62nd American Society of Hematology (ASH) Annual Meeting offer glimpses into the complexities of a COVID-19 infectionsuch as more information about who is at greatest risk of severe illness and complications.

One of the studies presented at ASH 2020 sheds light on which individuals with blood cancers are most vulnerable to severe illness and death based on an ongoing global public reference tool. This tool is from the ASH Research Collaborative  and offers real-time data summaries to help guide treatment approaches for patients who have hematologic conditions.

Results of a study of 656 people with various types of blood cancers who also had COVID-19 infection found that one out of five had died between April and November, based on an analysis of data from the ASH Research Collaborative COVID-19 Registry for Hematology. For those who needed hospital- or ICU-level care, 33% died. This international registry, which launched in April, is giving near real-time data to hematologists and other clinicians who are caring for patients amid the pandemic and offering important insights into which patients are most vulnerable to severe illness and death.

The present analysis includes registry data for 656 patients (77% aged 40 and older) with various types of blood cancers collected between April and November from over 100 study sites around the world. Of these, 20% died. The most represented malignancies were leukemia (57%), lymphoma (25%), and plasma cell dyscrasia (18%). Patients, who had a laboratory-confirmed or presumptive diagnosis of SARS-CoV-2 infection, presented with a myriad of symptoms, most frequently fever (65%), cough (56%), dyspnea (39%), and fatigue (31%).

“We have seen and continue to see that individuals with hematologic malignancies and COVID-19 infection appear to have more severe illness and a higher likelihood of death compared to the general population,” said lead study author, William A. Wood, MD, MPH, of the University of North Carolina at Chapel Hill. “This heightened risk of severe infection or death among these patients is concentrated in certain groups of individuals, and data from our global registry has helped to understand this more clearly.”

“This analysis highlights that patients with hematologic diseases are a medically vulnerable population when it comes to COVID-19 infection. It underscores the need for us to continue to encourage our patients to take appropriate precautions to limit exposure to COVID-19“

William A. Wood, MD, MPH, of the University of North Carolina at Chapel Hill

In particular, people with blood cancers who had the highest likelihood of dying were older, had more severe COVID-19 infection, had opted to forgo more intensive treatment, such as the intensive care unit (ICU), and/or had poorer prognosis before their COVID-19 infection as determined by their treating clinician (less than 12 months at the time of COVID-19 diagnosis). Patients with relapsed/treatment-resistant hematologic disease also appear to be disproportionately more likely to develop moderate to severe COVID-19 infection. 

“This analysis highlights that patients with hematologic diseases are a medically vulnerable population when it comes to COVID-19 infection. It underscores the need for us to continue to encourage our patients to take appropriate precautions to limit exposure to COVID-19, to continue to take precautions in our health care delivery environment to protect these patients, and to prioritize these patients for COVID-19 testing as well as vaccine distribution, once efficacious and safe vaccines are available,” said Dr. Wood. “On the other hand, we also saw that many patients with hematologic malignancies survived COVID-19 infection, including some who had severe disease and received ICU-level care. For this reason, it seems appropriate to pursue maximal care delivery for these patients as long as it aligns with patient preferences.”

Guidance for treatment decisions

Since its launch, the Registry has quickly accrued data, and researchers have been able to track how therapies to treat COVID-19 have evolved and shifted over time. It is expected that as more patient data is accrued over longer periods of time, researchers can track trends that can help guide practice and treatment decisions and ask more specific questions of the data. For example, the registry data could shed light on how patients with leukemia who have received specific therapies within a month of acquiring COVID-19 infection fare overall and whether their disease course is different. The registry will also allow clinicians to gain insights into potential regional differences in outcomes as well as the effects of other sociodemographic variables including race and ethnicity.

“This is a collaborative, global effort. We were able to launch this resource quickly and with a spirit of volunteerism and collaboration from around the world.  Hematologists recognize the value of these data and continue to contribute cases,” Dr. Wood said. “These data have given us a first look into how COVID-19 infection affects patients with blood cancers and will continue to provide actionable information to guide health care delivery during this time.”

Still, the database has some inherent limitations in that it is voluntary, so it does not capture all known cases of patients with blood cancers and COVID-19 infection. Dr. Wood said that this also means some of the rates of adverse clinical outcomes such as COVID-19 severity and mortality may be higher in this registry than in a true population-based dataset.

“We now have information from a resource spanning the continents, showing us that we have a high-risk patient population, but that most patients can recover from this infection,” Dr. Wood said, adding that this is particularly true for individuals with younger age, mild or moderate disease, and more than 12 months pre-COVID prognosis. “That should be reassuring.”

Moreover, the recorded death rate among patients has improved – dropping from 28%, which was seen among the first 250 patients and published concurrently in Blood Advances, to 20% with more cases included in the present analysis. Dr. Wood explained that while this may represent true improvements in outcomes over time, this cannot be stated with certainty as the precise dates of diagnosis were not recorded due to the de-identified nature of the registry data.